The emerging landscape of reimbursement of regenerative medicine products in the UK: publications, policies and politics

Aims This paper aims to map the trends and analyse key institutional dynamics that are constituting the policies for reimbursement of Regenerative Medicine (RM), especially in the UK. Materials & Methods Two quantitative publications studies using Google Scholar and a qualitative study based on a larger study of 43 semi- structured interviews. Results Reimbursement has been a growing topic of publications specific to RM and independent from orphan drugs. Risk- sharing schemes receive attention amongst others for dealing with RM reimbursement. Trade organisations have been especially involved on RM reimbursement issues and have proposed solutions. Conclusion The policy and institutional landscape of reimbursement studies in RM is a highly variegated and conflictual one and in its infancy

The consequences of the glitch in the interactive virtual environment.

Esta investigación pretende averiguar qué papel tiene el glitch, ya sea fortuito o intencionado, en el entorno virtual interactivo. El interés por tratar este tema surge como respuesta ante la falta de estudios enfocados en estos efectos. De igual manera, también surge de la reacción de la comunidad de jugadores ante estos fallos y por el potencial estético que tienen algunas de las capturas de estos fallos. El propósito es descubrir las consecuencias de estos efectos glitch, tanto los modificados como los inesperados, en espacios virtuales asociados con el videojuego, a fin de valorar, en ambos casos, las variaciones que provocan, principalmente, en el apartado visual, pero también en el mecánico y en el narrativo. Para eso, se ha optado por un enfoque académico-teórico para la construcción de la base teórica, así como se ha hecho uso del método art-based research para que la práctica artística entre en diálogo con la teórica y, finalmente, se ha hecho uso del método de programación extrema para el desarrollo práctico. Esta investigación se divide en dos bloques principales: el teórico y el práctico. El bloque teórico tiene dos vertientes: la primera pasa por un análisis de las definiciones que se le ha ido dando al concepto glitch y glitch-art, entrando también en la investigación sobre las distintas técnicas de producción glitch. La segunda parte va enfocada en los videojuegos que exploran la aplicación del glitch y las obras artísticas que cuentan con el videojuego como medio. El bloque práctico y resultado de la investigación consiste en un entorno virtual creado con Blender y Unity. Se compone de seis escenas por las que se puede navegar y experimentar, de primera mano, los efectos de distorsión glitch que se han aplicado. Con todo esto, se ha podido concluir de manera resumida que, a tra- vés del proceso de construcción de espacios y aplicación de efectos glitch, encontramos distintos recursos que pueden ser útiles por su valor formal y cromático. Se pueden rescatar fragmentos de imagen que tienen interés, ya que proporcionan nuevas formas y representaciones debido a su carácter parcialmente aleatorio. También se puede concluir que no todos los glitches que se aplican a estas experiencias pueden dar como resultado imágenes o experiencias de calidad, y que no se puede pretender tampoco que en el glitch no controlado proporcione una experiencia enriquecedora. Aun así, este tema de investigación es lo suficientemente amplio como para poder seguir trabajando en él. Con un buen estudio sobre las posibilidades se pueden crear experiencias que exploten aún más estos efectos.This research aims to find out what role the glitch, whether accidental or intentional, plays in the interactive virtual environment. The interest in addressing this issue arises in response to the lack of studies focusing on these effects. Likewise, it also arises from the reaction of the gaming community to these glitches and from the aesthetic potential that some of the captures of these glitches have. The purpose is to discover the consequences of these glitch effects, both modified and unexpected, in virtual spaces associated with videogames, in order to assess, in both cases, the variations they cause, mainly in the visual section, but also in the mechanical and narrative ones. For this purpose, an academic-theoretical approach has been chosen for the construction of the theoretical base, as well as the use of the art-based research method for the artistic practice to come in dialogue with the theoretical one and, finally, the use of the extreme programming method for the practical development. This research is divided into two main blocks: the theoretical and the practical. The theoretical block has two aspects: the first one goes through an analysis of the definitions that have been given to the concept glitch and glitch-art, also getting into the research on the different glitch production techniques. The second part focuses on videogames that explore the application of glitch and artistic works that use videogames as a medium. The practical block and result of the research consist of a virtual environment created with Blender and Unity. It consists of six scenes through which you can navigate and experience, at first hand, the glitch distortion effects that have been applied. With all this, it has been possible to conclude in a summarized way that, through the process of construction of spaces and application of glitch effects, we find different resources that can be useful for their formal and chromatic value. Fragments of images can be rescued that are of interest, since they provide new forms and representations due to their partially random character. It can also be concluded that not all glitches applied to these experiences can result in quality images or experiences, and that it cannot be claimed either that the uncontrolled glitch provides an enriching experience. Even so, this research topic is sufficiently broad to be able to continue working on it. With a good study of the possibilities, experiences can be created that further exploit these effects.Depto. de Diseño e ImagenFac. de Bellas ArtesTRUEsubmitte

Complicaciones neurológicas asociadas a alteraciones hemostáticas en perros críticamente enfermos : a propósito de 4 casos clínicos

El objetivo de este trabajo es describir las complicaciones neurológicas inusuales en el paciente crítico, secundarias a la presencia de alteraciones hemostáticas. Los casos estudiados fueron seleccionados a partir de perros atendidos en el Hospital Clínico Veterinario durante un periodo de 6 meses. Los pacientes estudiados fueron incluidos en base a los siguientes criterios: presencia de trastornos hemostáticos basados en los resultados del hemograma y las pruebas de coagulación; presencia de complicaciones neurológicas secundarias documentadas en signos clínicos; hallazgos de exploración, necropsia u otros exámenes complementarios. Cuatro perros cumplieron los criterios de inclusión, mientras que uno de ellos fue referido para evaluación neurológica. Los casos restantes desarrollaron signos neurológicos en la UCI. Tres de los pacientes evaluados presentaron complicaciones neurológicas asociadas a sangrado, mientras que el cuarto presentaba signos clínicos asociados a la presencia de trombosis arterial. Tres pacientes,o bien murieron, o fueron eutanasiados debido al desarrollo de complicaciones o al pronóstico desfavorable, mientras que la evolución en el perro superviviente, con un cuadro neurológico multifocal secundario a CID, fue excelente. El examen post mórtem-mortem realizado en 2 / 3 pacientes, confirmó la presencia de hemorragias, trombos de fibrina y lesiones por isquemia en el SNC. Según estas observaciones, la posible existencia de alteraciones en la coagulación debe ser tenida en cuenta cuando el paciente críticamente enfermo desarrolla complicaciones neurológicas de forma aguda. Dado que existe una elevada variabilidad por lo que hace referencia a las alteraciones analíticas detectables en los perfiles analíticos habituales y el estado real del sistema hemostático en el paciente crítico, la evaluación precoz y completa del estatus hemostático del paciente, así como el tratamiento de la enfermedad subyacente, son esenciales para poder anticipar este tipo de complicaciones

Mating system in a natural population of Theobroma grandiflorum (Willd. ex Spreng.) Schum., by microsatellite markers.

The aim of this research was to study the mating system of a natural population of Theobroma grandiflorum (cupuassu) from Nova Ipixuna, Pará state, using microsatellite markers. Eight polymorphic microsatellite loci were analyzed in eight families, each represented by 10 six-month old seedlings derived from open-pollinated pods. The estimation for the multilocus outcrossing rate ($tm= 1.0) and individual outcrossing rate ($t= 1.0) for this population suggests that T. grandiflorum may be a perfect outbreeding (allogamous) species. Likewise, for the studied population the estimate for single locus outcrossing rate ($ts) was elevated (0.946), but lower than$tm, confirming the likely outcrossing character of the species and suggesting the occurrence of 5.4% biparental inbreeding rate ($tm-$ts). The estimation of genetic divergence ($FST) between allelic frequencies in ovules and pollen revealed a deviation from random mating in 75$rp= 0.930) and the mean coefficient of co-ancestrality within families ($?xy= 0.501) indicated that the outcrossings were predominantly correlated, and the offspring were full-sibs. These results suggested that for this particular population of T. grandiflorum, the sampling strategy for genetic conservation and breeding should adopt specific models for families derived from correlated outcrossing (full-sibs) and not the ones usually adopted in classic outcrossing species breeding programs (half-sibs)

Designing prevention programmes to reduce incidence of dementia: prospective cohort study of modifiable risk factors

Objective To estimate the percentage reduction in incidence of dementia that would be obtained if specific risk factors were eliminated

Media Concentration in Spain: National, sectorial, and regional groups

In Spain, the media market structure is made up of very different media groups, making it necessary to identify and classify them in a clear and coherent manner. To do so, this article collects secondary information from media companies'' websites and from audience measurement institutions. Results identify 50 media groups with activity in the Spanish market. They are classified into three categories according to the type of outlet, including national, sectorial, and regional. The current structure is based on recent developments in the last four decades of democracy among newspapers, magazines, radio, television and digital media. © 2021 Universidad Complutense de Madrid. All rights reserved

Longitudinal algorithms to estimate cardiorespiratory fitness: associations with nonfatal cardiovascular disease and disease-specific mortality

Objectives This study sought to determine the capacity of cardiorespiratory fitness (CRF) algorithms without exercise testing to predict the risk for nonfatal cardiovascular disease (CVD) events and disease-specific mortality. Background Cardiorespiratory fitness (CRF) is not routinely measured, as it requires trained personnel and specialized equipment. Methods Participants were 43,356 adults (21% women) from the Aerobics Center Longitudinal Study, followed up between 1974 and 2003. Estimated CRF was determined on the basis of sex, age, body mass index, waist circumference, resting heart rate, physical activity level, and smoking status. Actual CRF was measured by a maximal treadmill test. Risk reduction per 1-metabolic equivalent increase, discriminative ability (c statistic), and net reclassification improvement were determined. Results During a median follow-up of 14.5 years, 1,934 deaths occurred, 627 due to CVD. In a subsample of 18,095 participants, 1,049 cases of nonfatal CVD events were ascertained. After adjustment for potential confounders, both measured and estimated CRF were inversely associated with risks for all-cause mortality, CVD-related mortality and nonfatal CVD events in men, and all-cause mortality and nonfatal CVD events in women. The risk reduction per 1-metabolic equivalent increase ranged from approximately 10% to 20%. Measured CRF had a slightly better discriminative ability (c statistic) than did estimated CRF, and the net reclassification improvement values in measured CRF versus estimated CRF were 12.3% in men (p < 0.05) and 19.8% in women (p < 0.001). Conclusions These CRF algorithms utilized information routinely collected to obtain an estimate of CRF, which provides a valid indication of health status. In addition to identifying people at risk, this method can provide more appropriate exercise recommendations that reflect initial CRF levels

Development of a new tool for assessing Health-Related Quality of Life in patients with primary hyperparathyroidism

Background: Several studies in recent years have evaluated Health Related Quality of Life (HRQoL) of patients with primary hyperparathyroidism (PHPT). No disease specific questionnaires are available to assess the impact of the disease. The aim of this research is to describe the development of a new disease specific Quality of Life (QoL) questionnaire for use specifically with PHPT patients. Methods: A conceptual model was developed describing the impact of the disease and its symptoms on QoL domains. A literature review was conducted to identify the most relevant domains. A focus group with experts was used to validate the domains; 24 patients were also interviewed to complement the information from the patient's perspective. A content analysis of the interviews was performed to identify items related with the impact of the disease, leading to PHPQoL-V.1 which was presented to a sample of 67 patients. Reliability was assessed by Cronbach's coefficient alpha and item-total score correlations. Validity was assessed by a factor analysis performed to determine the number of domains. Rasch analysis was carried out in order to refine the questionnaire items. Results: 259 items were extracted from the interviews that were subsequently reduced to 34 items. Cronbach's coefficient alpha was 0.92. The factor analysis extracted two domains (physical and emotional). After Rasch analysis the questionnaire PHPQoL-V.2 kept 16 items (9 physical and 7 emotional). The questionnaire was developed in a Spanish population and the final version was translated to English through translation and back-translation. Conclusion: The first disease specific HRQoL questionnaire for PHPT patients (PHPQoL-16) has been developed. Validation studies designed to assess measurement properties of this tool are currently underway

Utility of international normative 20 m shuttle run values for identifying youth at increased cardiometabolic risk

The purpose of this study was to examine the ability of international normative centiles for the 20 m shuttle run test (20mSRT) to identify youth at increased cardiometabolic risk. This was a cross-sectional study involving 961 children aged 10–17 years (53% girls) from the United Kingdom. Receiver operating characteristic (ROC) curves determined the discriminatory ability of cardiorespiratory fitness percentiles for predicting increased cardiometabolic risk. ROC analysis demonstrated a significant but poor discriminatory accuracy of cardiorespiratory fitness in identifying low/high cardiometabolic risk in girls (AUC = 0.58, 95% CI: 0.54–0.63; p = 0.04), and in boys (AUC = 0.59, 95% CI: 0.54–0.63; p = 0.03). The cardiorespiratory fitness cut-off associated with high cardiometabolic risk was the 55th percentile (sensitivity = 33.3%; specificity = 84.5%) in girls and the 60th percentile (sensitivity = 42.9%; specificity = 73.6%) in boys. These 20mSRT percentile thresholds can be used to identify children and adolescents who may benefit from lifestyle intervention. Nonetheless, further work involving different populations and cardiometabolic risk scores comprising of different variables are needed to confirm our initial findings